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tv   Book TV  CSPAN  November 19, 2011 8:00am-9:00am EST

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you will just be incredibly attractive. you already are. that is a great model. thank you for having me. i am really thrilled about this initial conference and it will continue. thanks. [applause].. and sweets live this weekend on c-span2.
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you can also look online for exclusive miami book fair webcasts at booktv.org. >> ethnic nationalism, tribalism, religious fundamentalism are far more powerful than ideology. and we're immune in this country from these forces. and when the melting pot has been thrown out and you're preaching multiculturalism, what holds us together? >> mr. buchanan's book is suicide of a superpower. and from new york city, the 62nd annual national book awards. find the complete schedule on booktv.org/booktv. >> paul farmer talks about the 2010 earthquake in haiti and the aid agencies that have been working there since. paul farmer was interviewed by a cbs correspondent.
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this is just under 50 minutes. [applause] >> i guess i'll just start it up. thank you so much for inviting me. i'm honored to down here. >> i'm sure your patients are worried about their endoscopies. it's having to do the prep without the procedure. that's what they're going to really be irritated at. [laughter] >> that's all right. they all know. i'm also -- i'm keenly aware that you are -- we have about 30 minutes. and that you're here -- you're here to to listen to paul, not to me. i'm going to be a facilitator of paul talking. on a personal note i want to thank you for chapter 2's practice and policy. because what that taught me is that if you highlight a word in the kindle, the dictionary pops up and you can learn what the
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word praxis means, formal practice. i want to thank you for that. >> my pleasure. that's why i wrote the book. [laughter] >> you're a physician. i'm a physician. you love to use physician metaphors, and you talk about the history of the present illness. let's start off -- and so that's going to be the arc of today's into 30 minutes. we'll consider haiti like a patient. let's start with the past medical history, okay? you start off with a country that in 1804 had its successful revolution rewarded in 1825 with fraction imposing a $25 billion reparation bill on them which took them over 100 years repay with interest. and it got worse from there. so you say the collapse has been ecological, economic and political. do you want to expand on that in about 20 seconds? [laughter] >> that's his revenge for his canceling his end oscopy.
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perry, thank you for having us here. i said in here on the way in here i can't imagine there would be anyone here on a monday morning so thank you all for making the effort. it's not a convenient time i'm sure for any of you and thank you, john, for doing this. by way of thanks and as a segue into the question, i also want to express at the outset my deep gratitude to the haitian people. and that sounds like a grandstanding move but let me be specific. and those of you here today who are haitian will know exactly what i'm talking about. the revolution that john lapook just mentioned -- i'm going to say john even though it's dr. lapook, that john just mentioned was the only time that in recorded history that a slave
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revolt has led to the founding of a nation. and when we heard about the french revolution in 1789 and its promises of liberty, equality and fraternity, how could that be true if there were slaves, right. how could that be a real human rights revolution. and the answer, of course, said the hashens said it couldn't be true. it wasn't -- it wasn't real. no offense to anybody here who is from france because i really love french food. [laughter] >> but it could not be meaningful without the haitian revolution. and the haitians will tell you -- and, again, this across all spectrums of haitian society, and most of my experience has been in the rural regions, places you've now visited as a physician and my knowledge of the haitian urban elites is actually quite limited. it's mostly through books,
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reading books that they've written. but across that spectrum, haitians will tell you that no small amount of their current problems are related to the haitian revolution and the price they paid for actually pushing forward these ideas. now, i said how can you say that in a more concise way and that's why i took this medical metaphor and for those of you who are not in medicine, we talk about the history of the present illness. that's when someone comes in with a complaint, different sort of complaints usually for john's patients than mine. >> i'm an internist here. >> i'm an internist too. they come in and say i'm coughing and losing weight for weeks or whatever it might be. and then you gathered the history of the present illness. you find out when this started and one of the things that we like to do -- and i put this in the book, maybe pushing it a little bit, in my work
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infectious disease work we always go chronologically and the patient may or may not have an idea about when a certain illness. they always do have an idea. i shouldn't say they may or may not have an idea but going back to a time when that patient was well and then moving forward. now, haiti was never well because it was a slave colony prior to the revolution and then it was a pariah nation that was being punished by the great powers of the time. >> and frightening to the united states. >> and very frightening to the united states. i always quote in books about haiti, on the senate floor, the senator from one of our states -- i won't mention which but it's a little bit south of north carolina. [laughter] >> saying, you know, the safety of our country forbids that we even talk about haiti. this is on the senate floor >> and obviously there were still slaves in the u.s. >> and that's when the first
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ambassador was when lincoln sent an ambassador. haiti has a very complicated history that goes back prior to the revolution when we sided with the slave owners as the only independent nation in the hemisphere, the only independent nation in the hemisphere. so we have this history, i think, also as two countries. as an american writing about haiti, that's always on my mind, too. what about our country and haiti? >> so that sets the stage because haiti, it's a lost cause. they just can't get their act together but really without knowing the history, you really can't even start talking about it. that's in the book that's terrific but sort of set the stage. >> excuse me. >> to even think about haiti because just coming into it raw, i think it's very hard for people just get it. let's just talk about the 800 pound gorilla in the room, ngos. i've been to haiti several times
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now and i've seen the amazing work that ngos including partners in health including the day the colorado group started in the same arc and he was interviewed and he was astounding as well as the colleagues from doctors without borders and other organizations and i went up north and i saw the difference between the care -- the health care people got in the mission, an ngo and then just going about several miles down the road to the public hospital which was astounding. i've never seen anything like that in my life. you walk in. there were literally no doctors there when i walked in. there were three guys who didn't have their md yet who were sitting there and they were training and they were going to call other doctors and the p were on the right and left. they had to bring their own sheets and their -- their family brought the food and there was no electricity. i mean, you cannot imagine that. so you have this big difference between the public and the
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private. but there have been -- their critics would say that there's this codependency between the ngos and the public government and you talk about this friction between taking care of the patient who's right in front of you, that's the doctor, that's dr. farmer, you're always dr. farmer and the person -- you can't even resist it and you're going to reach outlet and you're going to fix them. and taking care of the whole system, the anthropologist and the whole public care system. talk about that and about this whole controversy. >> well, the deposition and the controversy -- i'll try to give, you know -- i'll attack both of those. you know, and i'm here with some friends who barry met who just came in from new york who -- we've been working on some policy projects together. now, that sounds -- boy, that sounds like -- at 9:00 at night,
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everybody would just, you know, pitch forward in their seats and start snoozing. and i don't find policy discussions that interesting. but they are crucial to getting this right. and when we talk about build back better, we're not just talking about the destroyed infrastructure. we're talking about building aid back better. for example, you were in -- where the cholera outbreak history and where cholera came out, but that area was actually not touched by the earthquake. so what you saw when you went in -- there's no electricity, no doctors, you know, and a terribly underfunded public sector and then some pretty good ngo work. what you saw is part what needs to be build back better. so the tension between policy -- okay, you know what i shouldn't have used the word "practice." it was kind of smarty, old school marxist term.
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let it go. >> okay. i'll let it go. [laughter] >> you know, for my doctor friends who are here today including some i trained with, they know i would never say that during rounds. >> that was the longest take i'd ever seen and the guy pulls out the masking tape and he goes ow, didn't i make that comment 20 minutes ago. >> unlike gast roenterologists, we have long memories. [laughter] >> the practice or praxis. >> that's like an neurological term praxsis. >> taking care of them and public policy is what we should be confronting in build back better. ait's not even our own personal likes or dislikes. i like seeing patients but if i were sitting there -- i mean, cholera is a great example, you know, you can have as many patients as you want because the epidemic is out of control.
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so you have 425,000 patients already. >> and by the way, that translates in the united states to 12 million people. 12 million people for the united states. 6,000 dead is 180,000 dead in the united states, just to put it in perspective. >> we're not even sure -- it could be an undercount, of course, as you all know because reporting capacity is so weak. so this tension is in our lives and it should be in our lives. again, regardless of what our own -- i mean, in your life, for example, you see patients but you're also -- every time you go on the air or go to haiti or go to somalia, you're also taking on the big picture. i think that it's the same sort of thing when i write a book. of course, you know, you're seen by millions of viewers and 4 people read my book. i'm not bitter about it. [laughter] >> i know jamie from public affairs is here. she's fighting to -- you didn't
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let me finish the second had part of the question. >> you remember it. >> of course, i remember it. >> go to the second part. >> the 800-pound gorilla in the ngo and the codependency, just to jog your matter. we have a ct scan up for you. >> i think a functional mri would be a way to go. [laughter] >> what we wanted to bring into the book -- and here's my chance also to say thank you so abby gardener and jenny black and others who contributed to the book and helped to bring it into existence. because, you know, it takes a village as you said. [laughter] >> and by the way, when you read this book you should read -- read the end -- the part at the end that jenny wrote, didi his wife wrote and especially the witnesses to what was going on, you know, from right down there in rural haiti. don't just stop with his last
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word but really do read the parts at the end. >> with the 800-pound gorilla, the idea behind this book is i'm from an ngo. i'm a volunteer. but i am an ngo creature. you know, my real job is being a medical school professor but i've always, you know, believed in the work of partners in health and there are other great ngos working in haiti. at the same time, what's our long-term strategy to build aid back better? now, our strategy with partners in health have been hire local people, do local procurement whenever possible. and work to rebuild the public sector, you know, the public health institutions but it wasn't always that way. it was always a community-based organization with haitian employees but it's really been the last 10 years or so where we should, wait, what are we doing wrong? everybody says thank you for building a hospital in the middle of a squatter settlement or thank you for helping our kids go back to school. we get a lot of thanks from the people we serve and we say what
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are we doing wrong? we decided what we're doing wrong is to allow the continued degradation and collapse of the public sector which is after all haitian -- our employees are haitian too, but this is the institutions of that country, their public institutions allow them to collapse even as we grow. that's not the way to build haiti back better. and the earthquake was a chance, we hoped, not only to improve our own practice but also to improve the dialog with our ngo partners >> how does it translate in public health. i -- i was literally on a pile of rubble. rebuilding this is the easy part but rebuilding -- not even rebuilding, creating for the very first time a public health system. that's the tough thing. and you have all these, you know, whether it's 10 billion or 6 billion, however many billion have been pledged and however
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much is actually reached haiti which is another question -- it's more efficient for tomorrow to give that money to the ngo. they're going to help that person who's dying right there but really -- and you've written it needs to go to the -- to rebuilding the public health system, right? >> it does. and i'll give you an example of that i find uplifting and i haven't cleared this with the -- i'll just say it the american red cross, but they'll forgive me because i hope -- it's a positive story. they haven't told me i can't tell it. so -- >> the keys -- >> they're probably here. this is their hometown. anyway, so take the american red cross or the american federation of the red crosses, when there is a disaster people will give to the red cross. it has as they say in business parlance, it has a good brand. i watched -- of course, i only work, i never take breaks.
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i did not watch contagion this weekend with matt damon but if i had watched it, i would have seen -- by the way, pretty good -- pretty compelling outbreak. >> when he watched it with matt damon, he literally may have watched it with matt damon. somebody else was in the movie. >> you got to admit anything with him in it is good. so it's about an outbreak as you might imagine and there's the red cross. and i was thinking, oh, i'm going to -- well, had i been at the movie theater, if i'm going to washington tomorrow maybe i'll get to see my pals at the red cross. ngo, it's a nongovernmental organization. it raised a lot of money in response to the earthquake or katrina or any other visible, you know, disaster. whether we call them natural or unnatural, it doesn't matter.
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you're going to have people say i want to help. and everyone in a household donated. so the red cross is an ngo. they are used to working with ngos. they worked with partners without borders and let meize to anyone from doctors in the borders doctors who sometimes need borders. but having worked with them it was just kind of a joke but we can move like this. we can move very quickly the ngos. doctors without borders can move very quickly and so can partners in health. but what -- and thank you, red cross, for supporting us to respond to the suffering of cholera patients and reduce what is called case fatality rates which is a patient from a disease to 10 to 15% to zero. that's already done. if someone gets into one of these cholera treatment centers they're not going to die of cholera. but that does not replace a
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public water system. it does not replace a public hospital. it does not replace a public reporting system like the cdc, which does a lot more than reporting. as you can see i'm told about this movie i didn't see. but that's an example of -- so the red cross, we said to them, you know, help us keep the general hospital going. and you were there in the general hospital, haiti's largest hospital. and that's going to require finding a way to get salaries paid for workers. but how does that logistically happen? >> it logistically of happens because encouraging them to do it and maybe you want other groups to accompany us. the red cross accompanies us and we accompany -- my colleagues who are here from new york will tell me if i've done a good job
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talking about this. but that's a model of moving resources from the generous who have resources to the unfortunate who don't and let me just give one last number. there is a health ngo exhibit mention by name. it's not partners in health but partners in health is way up there too. that it raised $134 million for earthquake relief an international ngo and the ministry of health which you know was completely leveled by the earthquake and probably lost 20% of its -- or, you know, death -- dead or injured. the ministry of health which is still in a temporary shelter and now if you go back to that lot championship you will, there's not a stone standing there which is good because that means they cleared out the rubble. but they -- their budget is not a third of that. so that's the modern world distortion that we have going on in haiti. and all over the world.
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you've got one country -- this one, for example, where, you know, there would be tens of millions or hundreds of millions of dollars raised out of generosity going into a country where the public sector budget is for all -- help for the whole country is not a third for what one-third ngo raises for the ngo. a book i sent you but i bet you didn't read, i just compared the budget of the republic of haiti which is undergoing difficult times because cynical manipulation of aid by the international community which is a term that gets picked apart in this book, this is in 2003, what is the budget of the republic of haiti the budget was less than the city of cambridge with 100,000 people in it. those distort the work that we
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do and the 800-pound gorilla what he said wrapping it up neatlily, there are more ngos per capita in haiti than any other country in the world. so there's 1,000 ngo for every 1,000 ngos. 10 million people. >> and there may be more because we're not counting all the little bitty ones as president clinton would say the little bitty ones. everything he says sounds good, i find. [laughter] >> we have like 7 minutes left and i want to get for it because right now the patients are not undressed and we have to take them through the physical exam and get a diagnosis and a treatment and prognosis all that in 7 minutes. i know -- >> john, we know you didn't examine the patient. you just use endoscopy. >> i know this is is not -- you may know, everybody here wants to know what's happened to the
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money? >> yeah, in the way in here, one of my colleagues reminded me, it's not just about the pledges. it's obviously about do the pledges get delivered? and the answer is a very substantial majority of them do not. >> i think people need to know -- they want to know the numbers and they want to know what percentage goes to the public. >> i'm self-conscious because katherine gilbert is here and she should correct me. there are $5 billion or more were pledged and then there are some long-term pledges that were made as well. >> but the 2010/2012 was 6.2 billion and -- >> and you have to pick these part and that's why we have a website that really is just devoted to looking -- what are these pledges? are they recycled old pledges. >> what percentage also actually been -- >> i think we're pushing 30%, which is not bad.
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that means the majority is not delivered yet. >> of that went to the government? >> vanishingly small amount. maybe it's -- i'll tell you the number i do know, which is the acute relief. you've already given us a picture of why it's difficult to put acute relief money into the public sector because it was destroyed. i mean, 28 of 29 federal buildings in haiti were destroyed in the quake. imagine washington which, you know, this is one city. we have, you know, los angeles and chicago and new york -- it's all one city in haiti. and that city -- the nerve center was just leveled as you saw. the public infrastructure, the government infrastructure from palace to ministry, you know, to the -- our equivalent of even a building like this flattened so it was hard to put money in. i get that. and this is humility and we understand why it was hard for the big ngos and the so-called bilateral, means like cuba,
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haiti, those are bilateral and then the multilaterals like the world bank. but to have it less than 1% of the relief money i think we can't have done better. >> and that gives you some idea. i have to -- i'm going to reel you in a little bit if it's okay 'cause we talked beforehand that we could go on an hour on each one of these topics but i do just want to very quickly. first of all, i have to ask you the cue question, since we're doing the patient metaphor, what is haiti allergic too? >> haiti's allergic too, heavy-handed meddling and any assault -- real or perceived on its handling. and all of us -- i'm sure all of us read the newspapers yesterday or reflected on 911. and i read the "new york times" and just read a piece by a pakistani who i had the privilege of meeting actually in this city and this building and
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he writes about the impact of some of the thing that have happened since then on his own country and the popular perception of the united states. but in haiti it's deeper. there's much less fraud. there's been the american occupation of haiti which is a dark chapter for them. 1915 to 1934. but if we want to find out how to proceed we have to be aware of the allergy. that's a great metaphor. if i were to choose one thing perceived attack on the sovereignty. it doesn't have to be real. it's very hard to, you know, inform all one's work with that awareness of an allergy. >> we have 3 minutes so i wanted to talk about the diagnosis. i wanted to talk about rwanda, how it's a role model and what it can teach us following the 1994 genocide.
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i want talk about the role of the haitian diaspora. about the need to decentralize haiti. i want to talk about deforestation. i want to talk about the plight of women in haiti which is an amazing thing. there i was when katie couric interviewed -- this was back in april of 2010 a woman who had been raped and we know in the big camps and all around there, there is that problem. but since there's only 2 minutes left -- and then i loved the end where you're imagining all of the different scenarios to reconstruction. if you were king of the jungle, what it would look like so you're going to have to read the book but since we only have 2 minutes i thought the most delicious part of the book, although your parts were very tasty but for me the most delicious part was the woman who took the histories from the -- from the haitians and i want you to talk about it and what the haitians themselves are saying. because those are the people as you pointed out so beautifully who weren't at the table. they couldn't afford a ticket to fly up to the u.n.
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talk about that and that's how we'll end it and then we'll toss it to some questions. >> again, if the allergy, if i'm right about the allergy and i'm going to use this metaphor as if i didn't overuse medical metaphors, already to write a book about the earthquake even though i was there and working as a physician, it needed to have haitian voices. and a friend of mine -- and it's michelle montass and some of you may have seen the jonathan demme book. a martyr, that's his widow. he was killed in haiti who was murdered maybe 10 or 11 years ago. they're both radio journalists and prodemocracy radio journalists. i asked her if she would help on a project, not this book but -- and other people got together
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and decided to go out to all -- what is it 9 or 10 departments. i'm looking at jenny block. she bought the tape-recorders. you got to do things like that, too. you have to have the infrastructure of inquiry. and a group of haitians and a couple non-haitians but who spoke fluent creole, just spanned out and who asked people who are market women, fishermen or displaced people in the camps, school kids, farmers, not farmers like me but farmers with -- you know. you know, what do you want for your country? and the thing that was inspiring and as you said delicious was that they didn't say -- the theme that came back was not we don't believe in the future of our country. we don't -- none of that. they were actually optimistic
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about the possibility of reforming this state, making it work for the people, getting their kids back to school and rebuilding the country in a way that would make it easier for them to live in haiti. and there was something really inspiring about that theme and she does a great job on the -- writing the chapter. i haven't listened to the audio version of the book but she does her own chapter. i said, no, i want meryl streep to do mine because i'm the meryl streep of public health. >> i heard a story by the way i'm going to share that in new york there was a get-together and meryl streep was in the same room and everybody was around meryl streep and then paul farmer walks in and suddenly meryl streep was all alone in the corner. >> it was at nyu, not oscars. >> within a certain community of people -- >> meryl streep did read a lot of it but michelle reads her
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own. she has a beautiful voice. >> we love meryl streep. >> she's a great person. >> so just if you get a chance do listen and read what the haitians have to say about this and, michelle, thank you for it. >> my final question, doc, what's the prognosis? >> i think the prognosis -- if you go back to that chapter, the prognosis is good. someone said you should what's the allergy? what's the great resource of haiti? it's people. anybody can say that. but there's a lot of talent in haiti and a lot of young talent in haiti. there's lots of -- it's a young country, in terms of the demographics. we didn't get a chance to talk about the diaspora. but in the book, i write about some of my students from harvard who are haitian and who are, you know, so committed to working in haiti. and one of them -- i don't want to -- you can read about it. but one of them, you know, is a harvard -- he was a harvard
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medical school student who grew up in canada, you know, went to school, you know, in the united states as i said at harvard medical school and he said to me i remember the first week of school. he said -- of course all the physicians said hey, terry, what's up. he said i want to go to haiti. and he'd never been to haiti, it turns out. and i said what kind of medicine do you want to do? he said surge. we definitely have a place for someone who wants to do surgery. and he comes back working as an adult working in the operating room. he would work in the operating room in central haiti and spend the weekend with his family who he's getting to know again his aunts and uncles and many, many cousins. and his aunt and uncle were killed in the earthquake. expo brought all of his cousins -- and there were eight of them -- and i know that because he sent me an emailed picture of them in montreal with his parents. can you imagine we got our kids
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out. we're going to enjoy empty nest syndrome and then they get eight more. [laughter] >> that's the kind of story -- of course, that's a story of great adversity for that family but it's a great story of how the haitian people can be. yes, we'll take our cousins in. we'll make sure they grow up safely. and this young man -- i was going to say this kid is indeed now doing his surgical residency. i meet people like that a lot and we don't have enough of their stories out there. and so that's -- just as an example of not only the haitian people in haiti, you know, making the prognosis good but also there's a diaspora that i think we still have yet to draw on. >> haitians helping haitians. >> yeah, that's the big theme in the book. >> we're probably out of time for the q & a. >> that was a conversation. this is a q & a. >> i guess we should have questions. and please, i'm not sure.
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ask maul -- ask paul. >> dr. farmer, i'm here with some high school student leaders and colleagues and we are part of the episcopal schools education partnership in haiti. and about 2.5 hours there is a village called seval and we went last year for the first time and we're going again. about 400 families there. about 25% of the young people were malnourished and we go with a man and our question is -- >> he's good friend of me-in. >> we want to get community health workers there as well as
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food aid -- we're going to build them a school but even though that we would be more effective in figuring out a way to get the health workers in there and the food aid than he has been able to do. and so can you give us some advice on how to do that? >> i sure can. you know, it's great that the students who are with you and you their teacher are willing to shoulder some of this burden. he has so many duties as do a lot of people who serve as he does as a living link between in this case the united states and haiti. and that's a very difficult role. i've done it all my life is to be -- you end up being a choke point as well, right? i told you half of american households donated haitian earthquake relief and on the other end there's great need so it's hard to believe in the middle because you don't want to -- and i want you to take my
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advice as more advice to you than to him. he's already working 60 hours a week or however many. and my advice to you is, if you're going to get involved in food aid, try and think about food security and food sovereignty. and this is my colleagues from new york, i make them sound like people with briefcases and my colleagues from new york. they're actually all ladies in smart suits but we're working on this because we're not trying to say you need to handle food security better. but you need to think of a local feud procurement and this is the way we've done it. haiti is the most inwould your food country in the hemisphere. 25%, doesn't surprise me. and, unfortunately, what's happened with food aid if you go
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back to the history of food aid in haiti it's largely surplus grain from the united states or canada or elsewhere -- i'm not going to say dumped. but that is being moved to haiti which can then increase this cycle of dependency because it undercuts the value of local food production, right? and we did this for years. you have a school lunch program, you know, we still -- probably still doing it. we're trying to move away from that and not use those food sources. but by produce locally. and we're not -- we're not there yet. but ideally that's where we're going because then you support local farmers. you make sure kids get a nutritious meal which, of course, everybody -- every study shows that for kids not to get a meal in school means they perform less well. that's true in the united states as well as haiti. but it's especially true when the best meal of the day is of coming during school.
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so that's one thing. help to take that burden off the shoulders and don't impose anything on him but try to have that maybe a pilot project for the schools. so that's one bit of advice. for the health workers very specific advice. find a way to allow them to make a living being health workers. we've worked -- actually to the world bank. we worked with the world bank here in washington because i don't have international financial institutions are so obsessed with what they call sustainability that they recommend that that cadre of health providers not be paid at all. how can you be a health care worker -- i mean, it's got the w word in it work, as my daughter would say, work, how can you be a health care worker if you're a volunteer? you know, people like me should be volunteers or people like those being paid by the world bank should be volunteers. but the workers -- the women and
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men who are doing that work cannot afford to be substantial, you know, interveners in their own villages that they can't -- if they have to be volunteers or charge poor people for their services. so those are two very specific suggestions for you and your students. please give my best to the father. >> we're headed towards -- i know it's going a little long so somebody tell me 'cause it's like, what, 3 to 10? >> my colleague jenny block who happens to be a theologian, the other people come to washington with their lawyers. i come with my personal theologian. >> byot. >> byot. >> she said we'll help. meet with my coworkers when you're down -- >> somebody tell me since i'm supposedly moderating what time we really -- [inaudible] >> yeah. >> i don't want to -- >> he's -- he's got a flight, i
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don't. >> no, i can stay. i know people want to ask questions. here's your chance. >> dr. farmer -- >> where are you? >> i'm here on your right, about halfway back. my name is bob abernathy. i'm with religion and ethics news weekly. whenever there's a disaster, there's just such an outpouring of desire to help. and over the years, and especially in haiti, a great many religious groups and people of faith have gone to haiti to try to help. i'm wondering since the earthquake, how do you assess the effectiveness, the usefulnesses in, the problems that need to be learned for people who go there with a strong religious motivation to try to help the least of these? >> it's a hard question, meaning, it's a morally and personally hard question to ask but i'm glad you did. i think that -- i don't doubt for a minute the motivations --
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and even if i did, i wouldn't mention it. [laughter] >> so i'm not interested in that. the motivations -- i assume the best, right? so it's not about that. these are people in my experience people of good will. one of the contributors to the book wrote a very grim book about this called travesty in haiti and i invited him to participate in the book 'cause i think we need critical -- he has a much worse experience than i do. and his name is timothy schwartz and he's a very learned person, speaks creole and has lived in haiti for years so you can read his take on this but i have a lot of experience with people like the -- i didn't catch the school teacher's name but i will later. i worked with a lot of good people including people of faith working with church-based groups. a lot of good experience. now, the question -- you didn't ask did i meet a lot of them or what was their motivations was how effective has it been. i would say not give ourselves
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more than a c grade. i'm inspired by the school kids, the high schoolers. we shouldn't, right? because you look at all the good will and you look -- i just told you haiti is the almost food insecure company. half of all school-aged children in haiti were not in school. and so we can't be patting ourselves on the back too much. we should pat a little bit lower. >> good. >> it goes back to this business, right, of having to empower and everybody talks about this really who's thought about this for 14 seconds you need a good strong central organization, public health system and then maybe these ngos -- right now, the ngos will go back to the patient metaphor. it's like having 100 patients to one doctor and, again, something will get lost in the sauce.
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if you can coordinate and have them facilitation of a central organization you know what? we don't need 5 buildings within 100 yards of each other. why don't we spread them out. the decentralization of haiti because it's all -- a lot of it is in the capital and it needs to go out to the rest of the country. >> well, mr. abernathy, let me just say another thing is this book is aimed to -- it's a loyal critique, an inside critique of the ngos, of the u.n., of the development machine. it's not a savage critique. it's saying how can we do better as you just did. >> but the 80-pound gorilla in the room, if organized correctly these ngos could be much more effective. so they're doing amazing stuff. i saw with my own two eyes. >> yeah. >> amazing stuff. >> saving lives but imagine what they could be doing if they were coordinated in a more effective
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way. >> in general to many church-related, synagogue-related, mosque-related, all religion-related groups, what would be your message? >> my message would be, you know, although your mission is maybe different from the, say, public education and public health -- and i'm talking about those two areas largely, although we got to talk about agriculture and food security -- even though your mission is different, it can be complementary to the goals of the public health and public education and public water systems. let me put it even more -- with more humility on my side. don't forget cholera, i'm pointing at him not because he's -- >> that i have cholera. cholera spread like wildfire through the very part of haiti where we'd been working for 25 years. imagine how that felt. it's a disease. it's a water-bourne disease and there we are for 25 years to 10
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years and it spread right along that river system. so people -- we should feel, gee, you know, we didn't do everything right or, you know -- what we did do right we built infrastructure that could again save lives but that's not only about saving lives. it's about preventing cholera. church groups, mosque-related groups, synagogue-related groups -- it's not necessarily their mission to go and promote water security. but if it's their mission to help their neighbors, which it always is, then we're going to have to think -- rethink and think hard about how we can work together. the clinton foundation -- and i'm assuming this is a general -- of general interest as well in addition to of interest to mr. abernathy -- the clinton foundation put together a list of health-related ngos for the ministry of health and it's really the first time that we've really registered as health-related ngos.
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now, these are larger health ngos like doctors without borders, partners in health, save the children, et cetera, but it was the first time that this had been done and, again, using a platform, a technology platform that everybody should be using. and we have -- i think it's going to be good to do that with church groups as well. >> and, you know, one of the things that's a theme of this book again is trying to think correctly even if it's painful. >> yeah. >> and it is painful sometimes. you have the best intentions. i saw real magical thinking when i was there when the cholera epidemic was happening. there were people -- officials saying it's going to be contained and stay right there and i actually went on air and said this is magical thinking. there is no possibility that it's not going to spread because you have -- among every other reason, you have an incubation period of up to five days. people can be perfectly fine and then go to other parts of the country and spread it. there was no chance. there is this need especially in
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tough times to just think correctly, even if it's not what you want to really hear. >> well said. >> we have time for one more question? >> dr. farmer, my name is emily bauman. i'm right over here. i'm pursuing a master's in international development in american university and i was reading pathologies of power when the earthquake -- >> see, someone read it. >> my dad gave it to me for christmas. but i was just wondering if you could comment how the earthquake influenced the views that you express in that book particularly about -- the u.s. ambivalence toward haiti and whether or not you think that has changed or it's moving in the right direction or if we still have work to do? >> you know, my views of the history of the united states and haiti are not really very subject to revision unless there's some new cache of troves i missed like the 1987
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wikileaks. [laughter] >> so looking backwards, none of that -- i already knew there were good people in government on both sides. i already knew -- of course, i'm older and i hope wiser. i already knew there were good people on both governments. i knew there were good people -- i knew there were generous people. partners in health has grown as perry said into a very large concern mostly because of the generous support of private individuals. i know that. the question that i would ask and have been trying to ask publicly -- i don't do that much of that but i've done a lot of it this summer. do we need to have a mean-spirited foreign policy towards haiti? and the answer is, of course, we don't. so i don't think we're stuck in the same pattern necessarily. i think there are people of good will -- the difference, of course, from 1804 when there were two independent countries in the hemisphere -- the difference was there were only two. the united states and haiti is now one of them has become probably the most powerful country in the world and one of
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them has become very trampled upon and poor. it had those origins as well in one sense but also glorious origins, right. so that historical trajectory has pulled these two peoples apart when they should have been allied as the haitian were with the independence movement in south america with bolevar. so my answer to that question which is as usual -- paul, conscission is not your strong suit. so my answer to that question is we don't have to be stuck in that, you know? we can change our policy and i think there are people in the u.s. government right now who are committed to changing those policies and making them better and having them be of -- you know, based on again knowledge of that allergy. >> i have a perfect way to end this. you had your imagineering on the end where you were fantasizing
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about the bad scenarios. give me the good one, everything goes perfect in the year 2015. >> yeah, well, unfortunately -- and i hate not being able to -- i hate having to say this, unfortunately, the good one can't really happen, the really good one because you need to have -- for that you need to have full inclusion of all of the haitian adults, you know, and there's a saying, you know, that means including them in the democratic process voting. that means all the parties and groups and group of schools need to be engaged. that hasn't happened but that doesn't mean that we can't hope for a really good performance from the ngos, the church groups that were mentioned already, the haitian government, the international players. so if everything goes forward now as best we can and i think this is something people of good will should be committed to, we
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need to find ways to help the haitian government. first of all, it has to be formed. there's still no government in place. you need a prime minister. so let's hope maybe this week there'll be a prime minister. i want haiti to have a government just like i want my own country to have a government. and let's hope it's formed. that good people are in it and that they find real solidarity. what will haiti look like? there will be a major series of public works programs for reforest station at this time our link to infrastructure and -- just one little tiny example. how can you reforest haiti without an alternative fuel source for cooking. >> they grow the trees -- they grow the trees. it got to be a sapling and they cut it down because they need it for firewood. you can't imagine on the dominican republic it's green. >> one last optimistic point in medical care which is not the main thing but it's pretty important, right, to have medical care not that we're
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biased, we're -- the hospital that's described in the book which is in central haiti -- first of all, it's not in the capital. it's built to rigorous earthquake standards and it will be done or openable on the second-year anniversary. and to me my experience working in haiti you can get stuff done. just this past month, our groups including the haitian public sector opened a new residency training program in family practice in a city you've visited during the cholera epidemic which is still going on by the way. we checked on progress in the hospital. and the -- our esteemed foundation reopened the medical school with cuban faculty. let me tell you there are 1500 cuban health professionals. they are great. they are unsung heroes. they helped us a lot with cholera and also with teaching.
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there's lots helping in health care and medicine. that's my area and yours. but people also need to know these positive stories and then we again -- let's all be committed to helping the haitian people and the people they chose to lead them regardless of our own personal leanings or proclivities. it's really not the point. can we help the haitian people and their leaders move forward? i think we can. i'm gearing myself up for some optimism like from what we heard by people being interviewed by michelle montass. if they can have some optimism in their beliefs how do we feed our kids and have a safe place? we're not subjecting these pleasures. if those people can have optimism then we can too. thank you all for having me here. [applause] >> well done. for more on dr. paul farmer and the work he does, visit the
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partners in health website at pih.org. >> here's a short author interview from c-span's campaign 2012 bus as it travels the country. >> what qualities in a candidate would incentivize voters to hire or fire them? >> it's not exactly the way i approach the question in the book because that's really up to the voters. voters have a variety of different characteristics that they consider important. empirically the characteristic that voters find most important in candidates is party id. that is the primary determinative vote choice. the second characteristic at least in congressional elections that voters consider important is prior experience. so when we look at voters' behavior empirically those are the two factors that voters consider most strongly when deciding whom they want to hire or fire. >> in your book you compare
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competitive elections with the structure of, you know, a corporation, that when an employee is not performing they should be fired. what is the disconnect between competitive elections and that system that you discuss in your book. >> so the disconnect there are a lot of different definitions of a competitive election. one of the things i talk about quite a bit in the book is the fact that people have conflicting definitions of what a competitive election is. so, for example, two closely associated definitions of the competitive election are elections in which the final vote tallies for the candidates are very close and elections about which we are uncertain about the results. they're related but different definitions of a competitive election. so if we talk about uncertainty, for example, what does that mean? well, if an election is a way to hire or fire somebody and you have an incumbent running for office, then essentially what's happening is there is -- there's an employee whose contract is up for renewal. do we renew that employee's
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contract or not? that's literally what an election with an incumbent is. so let's think what it means by having a competitive election. if it's an election upon which we are uncertain and there's some sort of random element, then essentially a competitive election in the case of an incumbent iss to ago coin to decide whether or not to fire an employee. that's not a good idea. if you want a strong company, what you do is retain the employees for doing a good job, dermisicly and fire the employees who are doing a bad job, dermisicly. what you don't do is flip a coin but that's what a competitive election is, if we go with the definition of uncertainty. there are other definitions of a competitive election which run into other problems. but the basic issue is if you think about elections as an employment mechanism, most of the definitions of a competitive election don't really make a lot of substantive sense. >> what suggestions do you make in your book to improve the system? >> essentially the argument of
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the book is that if you want a healthy company, what you do is pose a credible threat to fire employees who do not do a good job. but the purpose of doing that is to give employees the incentive to do a good job. as a result they don't get fired. if you still to have fire people, that means something went wrong. so the argument i make in the book is that elections should operate in a way such that there is a dermisic threat to fire incumbents who do a bad job and that threat causes them to behave in such a way to avoid being fired. that's how i think electoral system should operate. and what that does is avoid most definitions of a competitive election because if that happens, then we will not on or about elections that are close or marginal. he will with not on or about uncertain elections. we will not on or about a lot of turnover in elected officials. we will not see those definitions of a competitive election. so the important thing that i argue in the book is that we pose a credible threat, but as always the case with the threat,
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if you have to carry out the threat, it means something went wrong. >> so how do you suggest that we pose the credible threat for candidates to take the election process more seriously or at least their political performance? >> that's voters' responsibility. there's nothing we can do to force voters to pose that credible threat. we can play around with election law to some degree. but ultimately if voters are not willing to pose that threat, there is nothing that we can do, in a policy sense, to pose that threat. or to force voters to pose that threat. it's the pontiac of voters just as it is the responsibility of employers to pose that threat to employees. and if employers do not pose that threat there is nothing you can do structurally to create that threat. >> so who's the audience that you would like to read your book? >> so there are a couple of audiences. a large part of the audience is scholars, people who study elections in a variety of different ways.

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